Dehydration and End-of-life Care

There are several common causes of dehydration. It is important to understand how hydration and dehydration impact end-of-life care.

Common Causes Of Dehydration

• Diarrhea, vomiting: Severe, acute diarrhea (diarrhea that comes on suddenly and violently) can cause a tremendous loss of water and electrolytes in a short amount of time. If you have vomiting along with diarrhea, you lose even more fluids and minerals.
• Fever: In general, the higher your fever, the more dehydrated you may become. The problem worsens if you have a fever in addition to diarrhea and vomiting.
• Excessive sweating: You lose water when you sweat. If you do vigorous activity and don’t replace fluids as you go along, you can become dehydrated. Hot, humid weather increases the amount you sweat and the amount of fluid you lose.
• Increased urination: This may be due to undiagnosed or uncontrolled diabetes. Certain medications, such as diuretics and some blood pressure medications, also can lead to dehydration, generally because they cause you to urinate more.

Complications Of Dehydration

Dehydration can lead to serious complications, including:

• Heat injury: If you don’t drink enough fluids when you’re exercising vigorously and perspiring heavily, you may end up with a heat injury, ranging in severity from mild heat cramps to heat exhaustion or potentially life threatening heatstroke.
• Urinary and kidney problems: Prolonged or repeated bouts of dehydration can cause urinary tract infections, kidney stones and even kidney failure.
• Seizures: Electrolytes such as potassium and sodium help carry electrical signals from cell to cell. If your electrolytes are out of balance, the normal electrical messages can become mixed up, which can lead to involuntary muscle contractions and sometimes to a loss of consciousness.
• Low blood volume shock (hypovolemic shock): This is one of the most serious, and sometimes life threatening, complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body.

When Is It Not Safe To Administer Fluids

There are times when it is unsafe to administer fluids, especially in end-of-life care.

• If the patient is no longer able to swallow or coughs/chokes when given fluids
• Patients who are on fluid restrictions due to cardiac disease or kidney failure
• If the patient is unresponsive or actively dying

Hydration & The Hospice Patient

Education about hydration, dehydration and the patient nearing end of life is important.

• People worry that a person would die of thirst if they did not drink fluids
• If someone is near the end of their life, it is natural to stop drinking
• Studies show that people who are near the end of life do not feel thirst
• People who are dying from a disease such as cancer or dementia often stop drinking
• These people do not die from thirst, but from their disease

When someone is at the end of their life, NOT drinking may help the body feel less pain

With less fluid, there is

• Less urine and less need for a tube in their bladder to catch the urine
• Less swelling of the legs and feet (edema)
• Less fluid buildup in the stomach, so less nausea and vomiting
• Less water buildup in the lungs, so fewer breathing problems
• There may also be less noisy breathing that sometimes occurs when a person is dying

References & Resources

• https://www.mayoclinic.org/diseasesconditions/dehydration/symptoms causes/syc 20354086
• https://www.mayoclinic.org/healthy lifestyle/nutrition andhealthy eating/in depth/water/art 20044256
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC 2908954